• North Africans take tea of powdered leaves and pods, with or without rose leaf, as laxative and purgative (BOU).

• Saudis use leaf decoction, alone or with other herbs, as laxative for cramps and constipation (GHA).

Downsides (Alexandrian Senna):

Class 2b, 2c, 2d (AHP, 1997). Commission E and other sources report interaction of anthranoid laxatives (AEH). Anthranoid-containing laxatives can be habit forming; some contain compounds suspected of being cytotoxic, genotoxic, mutagenic, and even tumorigenic; epidemiological studies in Germany reveal that abusers of anthranoid laxatives have a three-times-higher rate of colon carcinoma. One woman developed clubbing of her digits and hypertrophic osteoarthropathy after taking at least three tablets daily for 3 years for weight loss. She also experienced several months of secondary amenorrhea. Of senna leaf, Blumenthal et al. (1998) list abdominal pain of unknown origin, acute intestinal inflammation (e.g., Crohn's disease and colitis ulcerosa), and appendicitis as contraindications. Should not be used in lactation, during pregnancy, or with children under 12 years old (KOM). Occasional cramp-like discomfort of the GI tract may require dosage reduction (KOM). Side effects with chronic use or abuse: disturbance of electrolyte balance, especially hypokalemia (may be exacerbated by simultaneous administration of corticoadrenal steroids, licorice root, or thiazide diuretics) leading to cardiopathy and muscular weakness (especially with concurrent uses of cardiac glyco-sides, corticosteroids, or diuretics) (KOM). Pigmentation of the intestinal mucosa (Pseudomelanosis coll) is harmless and usually reverses on discontinuation of the drug. Simulating laxatives like this should not be used for more than 1 to 2 weeks without medical advice (KOM). Newall, Anderson, and Phillipson (1996) report anthraquinones are purgative and irritate the GI tract. Because of the anthraquinones, nonstandardized preparations should be avoided during pregnancy and lactation (CAN). "Anthraquinones may be secreted into breast milk CAN." Also contraindicated in hemor-rohoids and nephropathy (CAN), intestinal obstruction, abdominal pain of unknown causes, any enterosis (appendicitis, colitis, Crohn's disease, irritable bowel syndrome) hemorrhoids, nephropathy, menstruation (AHP, 1997). Do not use more than eight to ten days (AHP, 1997). "Do not use this product if you have abdominal pain or diarrhea. Consult a health care provider prior to use if you are pregnant or nursing. Discontinue use in the event of diarrhea or watery stools. Do not exceed recommended dose. Not for long term use" (AHP, 1997 CAN). "Some herbal laxative preparations such as cascara and senna, for example, can cause an increase in the potency of digoxin" (D'epiro, 1997 CAN). Pedersen cautions against taking the fresh leaf (we have done that in Peru with modest laxative results). "Senna causes gripping unless taken in combination with carminative herbs such as ginger, cloves, or various mint species. Although generally recognized as safe, senna is somewhat more habit forming than cascara" (PED CAN). Lininger et al. (1998) pronounce it "safe for children over the age of six" (half the adult dose) (SKY CAN). I'd be more cautious.

Extracts (Alexandrian Senna):

Possibly representing a negative case for my synergy proposition: "The toxicity of total extracts is greater than that of of the individual sennosides. It has been proposed that the laxative and toxic components of senna could be separated" (CAN). Elsewhere I have read that the sennosides are synergic as far as their laxative action is concerned. But then anomalously, Newall et al. 1996 report that Sennosides A and B are reported to be most potent with respect to laxative action, but the least toxic compared to other anthraquinone fractions. The LD50 values of sennosides A and B are 4100 mg/kg ivn mus and of rhein-8-glycoside 400 mg/kg ivn mus. All fractions had LD50 > 5000 mg/kg orl rat.

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